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Kikuchi M, Miyabe R, Matsushima H, Kita H, Kobayashi J, Ando T, Atsuta K, Shintani T. Tumor lysis syndrome following letrozole for locally advanced breast cancer: a case report. Surg Case Rep 2024; 10:100. [PMID: 38656713 PMCID: PMC11043241 DOI: 10.1186/s40792-024-01901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Letrozole, an aromatase inhibitor, is used to treat breast cancer in postmenopausal women. Tumor lysis syndrome (TLS) is a complication that can trigger multiple organ failure caused by the release of intracellular nucleic acids, phosphate, and potassium into the blood due to rapid tumor cell disintegration induced by drug therapy. TLS is uncommon in solid tumors and occurs primarily in patients receiving chemotherapy. Herein, we report a rare occurrence of TLS that developed in a patient with locally advanced breast cancer following treatment with letrozole. CASE PRESENTATION An 80-year-old woman with increased bleeding from a fist-sized left-sided breast mass presented to our hospital. Histological examination led to a diagnosis of invasive ductal carcinoma of the luminal type. The patient refused chemotherapy and was administered hormonal therapy with letrozole. Seven days after letrozole initiation, she complained of anorexia and diarrhea. Blood test results revealed elevated blood urea nitrogen (BUN) and creatinine (Cr) levels, and she was admitted to our hospital for intravenous infusions. On the second day after admission, marked elevations of LDH, BUN, Cr, potassium, calcium, and uric acid levels were observed. Furthermore, metabolic acidosis and prolonged coagulation capacity were observed. We suspected TLS and discontinued letrozole, and the patient was treated with hydration, febuxostat, and maintenance hemodialysis. On the third day after admission, her respiratory status worsened because of acute respiratory distress syndrome associated with hypercytokinemia, and she was intubated. On the fourth day after admission, her general condition did not improve, and she died. CONCLUSIONS Although TLS typically occurs after chemotherapy initiation, the findings from the present case confirm that this syndrome can also occur after hormonal therapy initiation and should be treated with caution.
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Affiliation(s)
- Masayuki Kikuchi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan.
| | - Rika Miyabe
- Tosen Clinic, 1-20, Gohuku-cho, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0031, Japan
| | - Hirokazu Matsushima
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Hidenori Kita
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Junko Kobayashi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Takashi Ando
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Koji Atsuta
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Tsunehiro Shintani
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
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Toda Y, Ashizawa M, Murahashi R, Nakashima H, Ikeda T, Kawaguchi SI, Nagayama T, Umino K, Minakata D, Morita K, Yamamoto C, Hatano K, Sato K, Fujiwara SI, Ohmine K, Kanda Y. Tumor lysis syndrome in induction therapy for acute myeloid leukemia before the rasburicase era. Int J Hematol 2024:10.1007/s12185-024-03752-w. [PMID: 38575822 DOI: 10.1007/s12185-024-03752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
Guidelines recommend rasburicase for high-risk patients to prevent tumor lysis syndrome (TLS). However, little information is available on the incidence and outcome of TLS in AML patients. We analyzed 145 patients with AML who underwent induction therapy before the approval of rasburicase to evaluate the incidence of TLS and the necessity of rasburicase as prophylaxis. Three patients had already developed clinical TLS (CTLS) at diagnosis of AML, and another three developed CTLS after the initiation of chemotherapy. In patients without TLS at diagnosis of AML, the risk for developing TLS was classified as high in 44 patients, intermediate in 41 and low in 57, according to the current guidelines. Allopurinol alone was administered to prevent hyperuricemia in all patients. All three patients who developed CTLS after diagnosis of AML were at high risk of TLS, and had elevated serum creatinine levels and a WBC count greater than 200,000 per microliter at diagnosis of AML. Allopurinol may be insufficient to prevent TLS in high-risk patients with renal dysfunction at diagnosis of AML, especially those with a high tumor burden and a WBC count of 200,000 or more, which indicates that prophylactic administration of rasburicase should be considered.
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Affiliation(s)
- Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Rui Murahashi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Hirotomo Nakashima
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shin-Ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shin-Ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
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Gartenberg A, Winkel M, Leonard N. Spontaneous tumor lysis syndrome in a patient with chronic myeloid leukemia treated successfully with allopurinol. Am J Emerg Med 2024; 78:242.e1-242.e3. [PMID: 38007380 DOI: 10.1016/j.ajem.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Tumor Lysis Syndrome (TLS) is an oncologic emergency that may occur in any patient with a hematologic malignancy, even prior to initiation of chemotherapy. Spontaneous TLS massive tumor cell destruction with intracellular electrolyte release prior to the initiation of chemotherapy. Spontaneous tumor lysis syndrome is a rare presentation, mainly occurring in Acute Leukemia and non-Hodgkin Lymphoma. Chronic Myeloid Leukemia (CML) is a low-risk disease based on TLS risk stratification. To the best of our knowledge, spontaneous TLS in the chronic phase of CML successfully treated with allopurinol and aggressive hydration has yet to be reported in the literature. A case report is described regarding a 67 year old Jamaican female with a history of hypertension who presented to the emergency department with abdominal pain, nausea, and vomiting for 1 day. The patient was found to have leukocytosis to 344,000 with 4% Blasts, hyperuricemia, and acute kidney injury. A peripheral blood smear confirmed the diagnosis of CML. Bone marrow biopsy was performed with evidence of the chronic phase of CML. The patient met clinical criteria for spontaneous tumor lysis syndrome. The patient was started on aggressive intravenous hydration, allopurinol, hydroxyurea and imatinib. Creatinine and uric acid level improved on this regimen within 48 h of initiation.
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Affiliation(s)
- Ariella Gartenberg
- Emergency Medicine, Jacobi Medical Center and Montefiore Medical Center, Bronx, NY, United States of America.
| | - Maia Winkel
- Emergency Medicine, Jacobi Medical Center and Montefiore Medical Center, Bronx, NY, United States of America
| | - Nicole Leonard
- Jacobi Medical Center and North Central Bronx Hospital, Bronx, NY, United States of America
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Schwaner I, Kuhn T, Losem C, Wolff T, Otremba B, Zaiss M, Hülsenbeck J, Famulla K, Nösslinger T, Rossi D. Low incidence of tumor lysis syndrome in elderly patients with chronic lymphocytic leukemia treated with venetoclax under real-world conditions: results from the prospective observational VeRVe study. Ann Hematol 2024:10.1007/s00277-024-05638-7. [PMID: 38421404 DOI: 10.1007/s00277-024-05638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
Venetoclax is active in both frontline and relapsed/refractory settings for the treatment of chronic lymphocytic leukemia (CLL). Although the prevalence and severity of tumor lysis syndrome (TLS) are well characterized in clinical trials, laboratory and clinical TLS remain relatively unexplored in real-world clinical practice.In this prospective, real-world observational study, we aimed to determine the incidence and outcomes of TLS in patients with CLL receiving venetoclax outside a clinical trial. The study (VeRVe) was conducted in centers in Austria, Germany, and Switzerland.Two hundred and thirty-nine patients were treated according to local label with at least one dose of venetoclax. Patient demographics, baseline characteristics, and blood chemistry at baseline were documented, and descriptive statistical analyses were conducted.Seventy eight patients (33%) were treated with venetoclax monotherapy, 101 (42%) with venetoclax in combination with rituximab and 60 (25%) with venetoclax in combination with obinutuzumab. In all cases, the TLS risk mitigation strategy adhered to the ramp-up protocol. Median age was 73 years and 66% of patients were male. The majority of patients (75%) had relapsed/refractory CLL, 63/192 (32.8%) patients tested had a del(17p) and 93/134 (69.4%) patients tested had unmutated immunoglobulin heavy chain variable region gene (IGHV). Clinical TLS occurred in 5 patients (2.1%) and laboratory TLS occurred in 15 patients (6.3%). Ten patients received specific treatment, of which 6 were hospitalized. There were no deaths due to a TLS event and venetoclax was well-tolerated. Of the 5 clinical TLS events reported, none were fatal or resulted in renal failure (NCT03342144, registered on Nov 10, 2017).
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Affiliation(s)
- Ingo Schwaner
- Onkologische Schwerpunktpraxis Kurfuerstendamm, Kurfuerstendamm 65, 10707, Berlin, Germany.
| | - Thomas Kuhn
- AbbVie Deutschland GmbH & Co. KG, Hämatologie, Wiesbaden, Germany
| | | | | | | | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Kirsten Famulla
- AbbVie Deutschland GmbH & Co. KG, Hämatologie, Wiesbaden, Germany
| | - Thomas Nösslinger
- 3rd Medical Department for Hematology and Oncology, Hanusch Krankenhaus, Wien, Austria
| | - Davide Rossi
- Clinic of Hematology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
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Bozkurt S, Genc DB, Vural S. Laboratory and clinical features of tumor lysis syndrome in children with non-Hodgkin lymphoma and evaluation of long-term renal functions in survivors. BMC Pediatr 2024; 24:85. [PMID: 38297237 PMCID: PMC10829167 DOI: 10.1186/s12887-024-04549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE The purpose of our study is to investigate the laboratory and clinical features of tumor lysis syndrome (TLS) and acute kidney injury (AKI) in childhood non-Hodgkin lymphomas (NHL) and to reveal their impact on long term kidney function in survivors. METHODS Our single-center retrospective study included 107 patients (0-18 years old) with NHL who were admitted and treated at our hospital between 1998 and 2020. The relationship between TLS and age, gender, histopathological subgroup, tumor stage, lactate dehydrogenase (LDH) level at presentation, bone marrow and kidney involvement were assessed. The long-term renal functions of the patients were investigated. RESULTS 80.3% of the patients were male with a median age of 9.8 years. The most common detected histopathological subgroup was Burkitt lymphoma. Hyperhydration with or without alkalinisation, and allopurinol were used in first-line treatment and prophylaxis of TLS. Laboratory TLS and clinical TLS was observed in 30.8% and 12.1% of patients, respectively. A significant correlation was found between young age, advanced stage, high LDH level at presentation, and TLS. AKI was observed in 12.1% of the patients. When the glomerular filtration rate values of the patients at the first and last admissions were compared after an average of 6.9 years, a mean decrease of 10 mL/min/1.73 m2 was found. It was not, however, found to be statistically significant. CONCLUSION Lower age, advanced stage, and high LDH level at presentation were found to be risk factors for TLS in our study. Long-term renal function loss was not observed in the survivors who received early and careful prophylaxis/treatment for TLS. The survivors are still being followed up.
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Affiliation(s)
- Selcen Bozkurt
- Department of Pediatric Allergy-Immunology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Dildar Bahar Genc
- Department of Pediatric Oncology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sema Vural
- Department of Pediatric Oncology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Yasumi M, Yamamoto Y, Kamijo K, Kamae T, Yamato M, Karasuno T. Tumor lysis syndrome followed by tumor regression after COVID-19 in a patient with chronic lymphocytic leukemia. Int Cancer Conf J 2024; 13:22-25. [PMID: 38187172 PMCID: PMC10764681 DOI: 10.1007/s13691-023-00631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 01/09/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) can become lethal in patients with hematological malignancies; however, several cases of tumor regression after COVID-19 have been described, and the precise mechanism behind this paradoxical effect is unknown. Herein, we describe a case of Tumor lysis syndrome (TLS) followed by tumor regression after COVID-19. A 72-year-old woman with untreated chronic lymphocytic leukemia was admitted to our hospital with SARS-CoV-2 antigen-positive pneumonia. On admission, her anti-SARS-CoV-2 spike antibody was negative despite receiving two prior vaccinations. Immediately after admission, she developed confusion and ventricular tachycardia. Laboratory data showed acidosis, hyperkalemia, and a rapid decrease of tumor cells in peripheral blood, and she was diagnosed with clinical TLS. She was transferred to the intensive care unit and received continuous hemodialysis therapy. Although hyperferritinemia and bicytopenia, which suggest a cytokine storm followed, she recovered without steroids and additional COVID-19 treatment in 8 days. 2 months later, CT revealed a marked shrinking of lymphadenopathy, which was compatible with tumor regression after COVID-19. Considering the impaired humoral immunity and abrupt response, direct oncolysis caused by SARS-CoV-2 and cytokine storm-induced cell-mediated immune reaction may have been responsible for this paradoxical effect.
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Affiliation(s)
- Masato Yasumi
- Department of Hematology, Rinku General Medical Center, 2-3 Ourai-Kita, Rinku, Izumisano, Osaka 598-8577 Japan
| | - Yudai Yamamoto
- Department of General Internal Medicine and Infectious Diseases, Rinku General Medical Center, Osaka, Japan
| | - Kimimori Kamijo
- Department of Hematology, Rinku General Medical Center, 2-3 Ourai-Kita, Rinku, Izumisano, Osaka 598-8577 Japan
| | - Tsuyoshi Kamae
- Department of Hematology, Rinku General Medical Center, 2-3 Ourai-Kita, Rinku, Izumisano, Osaka 598-8577 Japan
| | - Masaya Yamato
- Department of General Internal Medicine and Infectious Diseases, Rinku General Medical Center, Osaka, Japan
| | - Takahiro Karasuno
- Department of Hematology, Rinku General Medical Center, 2-3 Ourai-Kita, Rinku, Izumisano, Osaka 598-8577 Japan
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Perissinotti AJ, Bishop MR, Bubalo J, Geyer MB, Goodrich A, Howard SC, Kula J, Mandayam S, Cairo MS, Pui CH. Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: Results of a modified Delphi panel. Cancer Treat Rev 2023; 120:102603. [PMID: 37579533 DOI: 10.1016/j.ctrv.2023.102603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Tumor lysis syndrome (TLS), which occurs spontaneously or in response to anticancer treatment, results in the release of intracellular potassium, phosphorus, and nucleic acids into the bloodstream, which results in secondary clinical complications that may be fatal. Prior TLS guidelines do not take into consideration potent novel oncologic agents or contemporary treatment paradigms with increased risk of TLS. Thus, a modified Delphi panel of experts was convened to provide an update for TLS management guidelines based upon a combination of supporting literature and practice consensus. METHODS A three-round modified Delphi process was implemented. For round 1, nine expert panelists completed a web-based questionnaire developed using published literature. In round 2, panelists were asked to reconsider their answers to questions that did not reach consensus (defined as ≥ 66% agreement among voting panelists). Round 3 was an unblinded, moderated virtual meeting to discuss any remaining questions that did not reach consensus. RESULTS Detailed recommendations are given for prophylaxis, monitoring, and management of TLS risks and complications, with hydration being a key element of TLS prophylaxis and management. Guidelines for the management of acute effects of TLS and prevention of long-term renal effects include management of hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia. DISCUSSION Although the control of uric acid levels is quite effective with currently available agents, panelists emphasize the importance of monitoring and treating other dangerous electrolyte abnormalities such as hyperkalemia and hyperphosphatemia. Guidelines from this modified Delphi panel should aid clinicians in preventing and managing TLS.
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Affiliation(s)
- Anthony J Perissinotti
- University of Michigan Health - Michigan Medicine, Department of Pharmacy, Ann Arbor, MI 48109, USA
| | - Michael R Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Joseph Bubalo
- Department of Pharmacy/Division of Hematology and Medical Oncology, OHSU Hospital and Clinics, Pharmacy Services, Portland, OR 97239, USA
| | - Mark B Geyer
- Leukemia and Cell Therapy Services, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Amy Goodrich
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Scott C Howard
- University of Tennessee Health Sciences Center, Memphis, TN 38103, USA
| | - Julianna Kula
- Rocky Mountain Cancer Centers, Greenwood Village, CO 80112, USA
| | - Sreedhar Mandayam
- Department of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mitchell S Cairo
- Department of Pediatrics, Cancer and Blood Diseases Center, New York Medical College, Valhalla, NY 10595, USA.
| | - Ching-Hon Pui
- Departments of Oncology, Global Pediatric Medicine, and Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Osborne KD, Osborne KC, Bedard PJ. A case of spontaneous tumor lysis syndrome in an adolescent with abdominal pain. Am J Emerg Med 2023; 73:234.e1-234.e2. [PMID: 37734989 DOI: 10.1016/j.ajem.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
Tumor lysis syndrome (TLS) is an acutely life threatening, must-not miss, oncological emergency that infrequently presents to the emergency department (ED). This diagnosis is typically a complication of chemotherapy, however, TLS can also occur spontaneously as the first presentation of malignancy. This case discusses the rare presentation of an otherwise healthy adolescent male who presented to the ED with abdominal pain and lethargy and was subsequently found to be in acute renal failure and pancytopenic with the associated lab derangements of hyperkalemia, hyperphosphatemia, and hypocalcemia. Subsequent investigation revealed profound hyperuricemia, from which the presumptive diagnosis of spontaneous TLS was made. Further workup revealed the diagnosis of pre-B cell acute lymphoblastic leukemia. This case emphasizes the consideration of TLS as a cause of acute renal failure or severe electrolyte derangements in those who may not have a known diagnosis of malignancy or recent chemotherapy.
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Affiliation(s)
- Katey D Osborne
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, USA.
| | - Kyler C Osborne
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, USA
| | - Patrick J Bedard
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, USA
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Dey A, Wyrebek R, Torres L, Escoto D, Shakeel F, Mayer J. Tumor lysis syndrome in premature infant prompting early resection of a large sacrococcygeal teratoma: a case report. BMC Pediatr 2023; 23:440. [PMID: 37660010 PMCID: PMC10474622 DOI: 10.1186/s12887-023-04193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/17/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Sacrococcygeal teratomas (SCTs) are the most common congenital neoplasm and often require resection soon after birth. There are rare reports of cardiac arrest during surgery due to manipulation of the tumor triggering secondary necrosis and hyperkalemia. CASE PRESENTATION This case describes a very preterm infant with a SCT who develops spontaneous preoperative tumor lysis syndrome (TLS). The medical team utilized rasburicase and the patient underwent total gross resection at 40 h of life. CONCLUSIONS We emphasize the importance of the early recognition and management of tumor lysis syndrome in SCT with rasburicase, aggressive management of hyperkalemia and consideration of early resection of SCTs even in the case of a very premature infant.
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Affiliation(s)
- Aditi Dey
- Maternal Fetal Neonatal Institute, Johns Hopkins All Children's Hospital, Florida, USA.
| | - Rita Wyrebek
- Maternal Fetal Neonatal Institute, Johns Hopkins All Children's Hospital, Florida, USA
| | - Loraine Torres
- Department of Obstetrics and Gynecology, Bayfront Medical Center, Orlando Health, Florida, USA
| | - Danilo Escoto
- Maternal Fetal Neonatal Institute, Johns Hopkins All Children's Hospital, Florida, USA
| | - Fauzia Shakeel
- Maternal Fetal Neonatal Institute, Johns Hopkins All Children's Hospital, Florida, USA
| | - Jennifer Mayer
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, Florida, USA
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Biró E, Erdélyi D, Varga P, Sinkó M, Bartyik K, Kovács G, Ottóffy G, Vincze F, Szegedi I, Kiss C, Szabó T. Daily serum phosphate increase as early and reliable indicator of kidney injury in children with leukemia and lymphoma developing tumor lysis syndrome. Pediatr Nephrol 2023; 38:3117-3127. [PMID: 36943467 PMCID: PMC10432329 DOI: 10.1007/s00467-023-05923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Tumor lysis syndrome (TLS) and its most serious complication, acute kidney injury (AKI) are one of the emergency conditions in onco-hematology. It is difficult to predict the degree of kidney involvement. Therefore, we studied children with leukemia and lymphoma treated in four Hungarian tertiary centers (inpatient university clinics) retrospectively (2006-2016) from a nephrological aspect. METHOD Data of 31 pediatric patients were obtained from electronic- and paper-based medical records. Physical status, laboratory test results, treatments, and outcomes were assessed. Patients were analyzed according to both "traditional" TLS groupings, as laboratory TLS or clinical TLS, and nephrological aspect based on pRIFLE classification, as mild or severe AKI. RESULTS Significant differences were found between the changes in parameters of phosphate homeostasis and urea levels in both classifications. Compared to age-specific normal phosphate ranges, before the development of TLS, hypophosphatemia was common (19/31 cases), while in the post-TLS period, hyperphosphatemia was observed (26/31 cases) most frequently. The rate of daily change in serum phosphate level was significant in the nephrological subgroups, but peaks of serum phosphate level show only a moderate increase. The calculated cut-off value of daily serum phosphate level increased before AKI was 0.32 mmol/L per ROC analysis for severe TLS-AKI. The 24-h urinalysis data of eight patients revealed transiently increased phosphate excretion only in those patients with TLS in whom serum phosphate was elevated in parallel. CONCLUSION Daily serum phosphate level increase can serve as a prognostic factor for the severity of pediatric TLS, as well as predict the severity of kidney involvement. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Erika Biró
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4032, Hungary
| | - Dániel Erdélyi
- 2nd Department of Pediatrics, Faculty of Medicine, Semmelweis University, 7-9 Tűzoltó U, Budapest, 1094, Hungary
| | - Petra Varga
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4032, Hungary
| | - Mária Sinkó
- Department of Pediatrics, Albert Szent-Györgyi Health Centre and University, 14-15 Korányi Fasor, Szeged, Hungary, 6725
| | - Katalin Bartyik
- Department of Pediatrics, Albert Szent-Györgyi Health Centre and University, 14-15 Korányi Fasor, Szeged, Hungary, 6725
| | - Gábor Kovács
- 2nd Department of Pediatrics, Faculty of Medicine, Semmelweis University, 7-9 Tűzoltó U, Budapest, 1094, Hungary
| | - Gábor Ottóffy
- Department of Pediatrics, Medical School, University of Pécs, 7. József Attila U, Pécs, 7623, Hungary
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 1. Egyetem Tér, Debrecen, 4032, Hungary
| | - István Szegedi
- Division of Pediatric Haematology-Oncology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4028, Hungary
| | - Csongor Kiss
- 2nd Department of Pediatrics, Faculty of Medicine, Semmelweis University, 7-9 Tűzoltó U, Budapest, 1094, Hungary
| | - Tamás Szabó
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, Debrecen, 4032, Hungary.
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11
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Papapanou M, Athanasopoulos AE, Georgiadi E, Maragkos SA, Liontos M, Ziogas DC, Damaskos D, Schizas D. Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature. Med Oncol 2023; 40:233. [PMID: 37432468 PMCID: PMC10335952 DOI: 10.1007/s12032-023-02108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
No systematic synthesis of all cases of spontaneous tumor lysis syndrome (STLS) in adult patients with solid tumors is available to date. Herein, we aim to recognize specific STLS characteristics and parameters related to a worse prognosis. We conducted a systematic search for randomized controlled trials, cohorts, case-control studies, and case reports. The primary endpoints were death and the need for renal replacement therapy (RRT) due to STLS. We estimated crude odds ratios (ORs) with 95% confidence intervals (95%CI) via univariate binary logistic regression. We included one cohort of 9 patients and 66 case reports of 71 patients [lung cancer 15(21.1%)]. Regarding the case reports, most patients [61(87.1%)] had metastatic disease [liver 46(75.4%)], developed acute kidney injury [59(83.1%)], needed RRT [25(37.3%)], and died due to STLS [36(55.4%)]. Metastatic disease, especially in the liver [p = 0.035; OR (95%CI): 9.88 (1.09, 89.29)] or lungs [p = 0.024; 14.00 (1.37, 142.89)], was significantly associated with STLS-related death compared to no metastasis. Cases resulting in death had a significantly higher probability of receiving rasburicase monotherapy than receiving no urate-lowering agents [p = 0.034; 5.33 (1.09, 26.61)], or the allopurinol-rasburicase combination [p = 0.023; 7.47 (1.40, 39.84)]. Patients receiving allopurinol were less likely to need RRT compared to those not receiving it or those receiving rasburicase. In conclusion, current anecdotal evidence demonstrated that metastatic disease, especially in the liver and lungs, may be associated with STLS-related death compared to no metastatic status. Careful surveillance of high-risk cases within larger studies is essential to identify markers predicting morbidity or mortality.
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Affiliation(s)
- Michail Papapanou
- Society of Junior Doctors, Athens, 15123, Greece.
- Second Department of Obstetrics and Gynecology, Medical School, "Aretaieion Hospital", National and Kapodistrian University of Athens, 76 Vas. Sofias Ave, Athens, 11528, Greece.
| | | | - Eleni Georgiadi
- 2nd Department of Radiology, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens, 1 Rimini Str, Haidari/Athens, 12462, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | | | - Michalis Liontos
- Department of Clinical Therapeutics, Division of Oncology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas. Sofias Ave, Athens, 10679, Greece
| | - Dimitrios C Ziogas
- First Department of Internal Medicine, Unit of Medical Oncology, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
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12
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Saillant A, Try M, Laparra A, Lecoq AL, Zaidan M. [Electrolyte disorders in oncological patients]. Bull Cancer 2023:S0007-4551(23)00209-6. [PMID: 37208250 DOI: 10.1016/j.bulcan.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
Electrolyte disorders (ED) are common in patients with cancer and in most cases, the etiologies do not differ from the general population. They may also be induced by the cancer, its therapy or paraneoplastic syndromes. ED are associated with poor outcomes, increased morbidity and mortality in this population. Hyponatremia is the most common disorder, often multifactorial, iatrogenic or secondary to the syndrome of inappropriate antidiuretic hormone secretion, usually due to small cell lung cancer. More rarely, hyponatremia may reveal adrenal insufficiency. Hypokalemia is generally multifactorial and associated with other ED. Cisplatin and ifosfamide induce proximal tubulopathies with hypokalemia and/or hypophosphatemia. Hypomagnesemia is often iatrogenic, related to cisplatin or cetuximab, but can be prevented by supplementation. Hypercalcemia can impair life quality and be life-threatening in the most severe cases. Hypocalcemia is less common and often of iatrogenic origin. Finally, the tumor lysis syndrome is a diagnostic and therapeutic emergency that affects the prognosis of patients. Its incidence tends to increase in solid oncology, related to the improvement of therapies. Prevention and early diagnosis of ED are essential to optimize the overall management of patients with underlying cancer and cancer therapy. The aim of this review is to synthesize most frequent ED and their management.
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Affiliation(s)
- Arnaud Saillant
- Centre hospitalier universitaire de Poitiers, service d'oncologie médicale, 86021 Poitiers, France; Groupe de recherche interdisciplinaire francophone en onco-néphrologie, Paris, France.
| | - Mélanie Try
- Groupe de recherche interdisciplinaire francophone en onco-néphrologie, Paris, France; Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service de néphrologie, dialyse et transplantation, 94270 Le Kremlin-Bicêtre, France
| | - Ariane Laparra
- Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service de médecine interne-immunologie, 94270 Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service d'endocrinologie et des maladies de la reproduction, 94270 Le Kremlin-Bicêtre, France
| | - Mohamad Zaidan
- Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service de néphrologie, dialyse et transplantation, 94270 Le Kremlin-Bicêtre, France
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13
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Calvache ET, Calvache ADT, Weber CS. Tumor lysis syndrome in hematological inpatients, experience from a university hospital in Brazil: A retrospective cohort study. Hematol Transfus Cell Ther 2023:S2531-1379(23)00074-3. [PMID: 37085347 DOI: 10.1016/j.htct.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/13/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION The tumor lysis syndrome is a medical emergency. Its presentation can be spontaneous or secondary, as a consequence of the established treatment. The diagnosis and treatment of the tumor lysis syndrome (TLS) has become a crucial goal to the evolution and improvement of treatments and targeted therapies. METHODS Between January 2014 and December 2019, we retrospectively reviewed inpatients aged over 18 years with hematological neoplasms from a tertiary hospital in Brazil. We identified 112 episodes of TLS in 97 patients. The incidence was 10.5% and the median OS was 13.0 months (95%CI 6.2 - 19.7). The median age was 56 years (IQR 39.5 - 64). The most frequent diagnoses were multiple myeloma (18.6%), acute myeloid leukemia (17.5%) and diffuse large B-cell lymphoma (17.5%). All patients received intravenous (IV) hydration. The management also included the administration of allopurinol in 76% of the cases and rasburicase in eight patients. Renal replacement therapy was necessary in 37% of the cases. In the multivariate analysis, age, HIV status and ICU treatment were significantly associated with OS. CONCLUSION The TLS is a serious complication in the setting of hematological malignancies. The use of scores for risk stratification, as well as the inclusion of prophylactic measures and prompt treatment with frequent laboratory monitoring, is essential to reduce morbidity and mortality in the comprehensive treatment of these patients.
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Majumdar S, Sharma N, Sengar M, Thorat J, Nayak L, Bonda A, Bagal B, Rajendra A, Sethi A, Jain H. A phase II study to evaluate the efficacy of low-dose rasburicase (1.5mg) in adolescent and adult acute leukemia and high-grade lymphomas with tumor lysis syndrome. Leuk Lymphoma 2023; 64:628-638. [PMID: 36891578 DOI: 10.1080/10428194.2023.2167491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The FDA recommended dose of rasburicase 0.2 mg/kg/day till the resolution of TLS or up to 5 days, might be in excess and is prohibitively expensive. The quality of evidence supporting low dose rasburicase is limited. The objective is to study the plasma uric acid response rate. This is a single center, non-randomised phase II study. Duration is 10 June 2017 till 30 July 2019. Study setting is at Adult Hematolymphoid Unit, Tata Memorial Center. Participants are patients with acute leukemia and high-grade lymphomas aged >/=18 years, with ECOG PS of 0-3, with either laboratory or clinical TLS. Rasburicase was administered at fixed-dose of 1.5 mg. The subsequent doses (1.5 mg each dose) were administered only if plasma UA levels did not decline by >50% on day 2, at the physician's discretion. We demonstrate that a low-dose rasburicase strategy leads to rapid and sustained reductions of uric acid in about 52% patients.
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Affiliation(s)
- Swaratika Majumdar
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Neha Sharma
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, India
| | - Manju Sengar
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Jayashree Thorat
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Lingaraj Nayak
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Avinash Bonda
- Medical Oncology, Homi Bhabha Cancer Hospital & Research Centre, Tata Memorial Centre, Mumbai, India
| | - Bhausaheb Bagal
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Akhil Rajendra
- Department of Medical Oncology, Cancer Institute WIA, Adyar, Chennai, India
| | - Amit Sethi
- Department of Electrical Engineering, Indian Institute of Bombay, Powai, India
| | - Hasmukh Jain
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
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15
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Hadjiyannis Y, Miller C, Hollie NI, Balakrishna J, Cottini F. Transformed Plasmablastic Lymphoma Presenting With Marked Lymphocytosis and Spontaneous Tumor Lysis Syndrome. J Hematol 2023; 12:49-58. [PMID: 36895289 PMCID: PMC9990712 DOI: 10.14740/jh1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
The clinicopathology entity of plasmablastic lymphoma (PBL), despite broad recognition by the World Health Organization (WHO), represents a diagnostic challenge due to its overlapping features and scarce occurrence. Often, PBL arises in immunodeficient, elderly male patients, most notably those who are human immunodeficiency virus (HIV)-positive. More infrequent, cases of transformed PBL (tPBL) evolved from another hematologic disease have been identified. Herein, we describe a case of a 65-year-old male transferred from a neighboring hospital with pronounced lymphocytosis and spontaneous tumor lysis syndrome (sTLS) presumed to be chronic lymphocytic leukemia (CLL). Utilizing a complete clinical, morphologic, immunophenotypic, and molecular evaluation, we arrived at a final diagnosis of tPBL with sTLS, suspected to have evolved from the NF-κB/NOTCH/KLF2 (NNK) genetic cluster of splenic marginal zone lymphoma (SMZL) (NNK-SMZL), a potential transformation and presentation, to our knowledge, not previously reported. However, definitive clonality testing was not performed. In this report, we also outline the diagnostic and educational considerations we faced in discerning tPBL from other more common B-cell malignancies which can present similarly, such as CLL, mantle cell lymphoma, or plasmablastic myeloma. We summarize recently reported molecular, prognostic, and therapeutic considerations for the treatment and recognition of PBL, including the successful implementation, in our patient, of bortezomib to an EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) regimen with prophylactic intrathecal methotrexate, who has since achieved complete remission (CR) and entered clinical surveillance. Lastly, this report briefly highlights the challenge we faced in this area of hematologic typification that necessitates additional review and discussion by the WHO: tPBL with potential double-hit cytogenetic versus double-hit lymphoma with a plasmablastic phenotype.
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Affiliation(s)
- Yannis Hadjiyannis
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Cecelia Miller
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Columbus, OH 43201, USA
| | - Norris I Hollie
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Columbus, OH 43201, USA
| | - Jayalakshmi Balakrishna
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Columbus, OH 43201, USA
| | - Francesca Cottini
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43201, USA
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16
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Issani A. An updated narrative review on the management of the most common oncological and hematological emergencies. Dis Mon 2023; 69:101355. [PMID: 35379468 DOI: 10.1016/j.disamonth.2022.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncological emergencies are defined as an acute life-threatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to end-stage disease. These oncological emergencies are broadly classified into four major categories; metabolic, structural, hematological and treatment-related causes; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. This study aims to cover an in-depth review of the underlying pathogenesis, clinical presentation, and updated management protocol of most common emergencies belonging to the above-mentioned categories. An all-language literature search was conducted on 15th October 2021 and 10th March 2022, limited to 5 years on PubMed database using the following search strings: oncological emergencies, malignant spinal cord compression, febrile neutropenia, hyperviscosity syndrome, superior vena cava syndrome, immune related adverse events, tumor lysis syndrome, hypercalcemia of malignancy, corrected calcium, malignant pericardial effusion and chemotherapy extravasation.
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Affiliation(s)
- Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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17
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Abd El-Fattah EE. Tumor lysis syndrome promotes cancer chemoresistance and relapse through AMPK inhibition. Int Immunopharmacol 2023; 114:109568. [PMID: 36527883 DOI: 10.1016/j.intimp.2022.109568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Cancer is a disease caused when cells divide uncontrollably and spread into surrounding tissues. There are different therapeutic modalities that control cancer growth, of which surgery, chemotherapy, and radiotherapy. Chemotherapy is a cancer treatment approach in which medications are used to inhibit cell proliferation and tumor multiplication, thus avoiding invasion and metastasis and thus eradicate cancer. One of the common complications associated with cancer chemotherapy is rapid lysis of expanding tumor cells, known as tumor lysis syndrome (TLS). TLS is associated with number of metabolic changes such as hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. Among the consequences of hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia is the inhibition of 5' AMP-activated protein kinase (AMPK). Inhibition of AMPK induced different cancer chemo-resistance mechanisms such as cancer stem cells (CSCs), p-glycoproteins, Octamer-binding transcription factor 4 (OCT-4), homeobox protein NANOG, Krüppel-like factor 4 (KLF4) and immune microenvironment and thus leads to poor response to chemotherapy and even relapses after treatment. Our review aims to uncover new mechanisms underlying the metabolic consequences of tumor lysis on AMPK in tumor microenvironment. In this review, we also investigated the effect of AMPK on different cancer chemo-resistance mechanisms such as cancer stem cells, p-glycoproteins, OCT-4, NANOG, KLF4 and immune microenvironment.
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Affiliation(s)
- Eslam E Abd El-Fattah
- Department of Biochemistry, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt.
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18
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Kikuchi S, Muro M, Kamihara Y, Wada A, Murakami J, Nabe Y, Minemura T, Sato T. Massive hyperphosphatemia in clinical tumor lysis syndrome during prophylactic rasburicase use: risk factors and treatment options. Int Cancer Conf J 2023; 12:69-74. [PMID: 36605847 PMCID: PMC9807691 DOI: 10.1007/s13691-022-00580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 76-year-old female with diffuse large B cell lymphoma who developed tumor lysis syndrome (TLS) and subsequent acute kidney injury (AKI) due to massive hyperphosphatemia during the prophylactic use of rasburicase. Our case showed no hyperphosphatemia before chemotherapy but had elevated uric acid and creatinine levels and unilateral hydronephrosis due to paraaortic lymphadenopathy. TLS risk was classified as high risk because of bulky mass, LDH elevation, and renal disturbance. With rasburicase use, uric acid was completely controlled but massive hyperphosphatemia and, subsequently, AKI developed. Immediate kidney replacement therapy led to improvement of hyperphosphatemia and AKI. In the rasburicase era, hyperphosphatemia has been a key target for preventing and treating TLS. Renal replacement therapy is the only effective option for lowering hyperphosphatemia and treating AKI.
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Affiliation(s)
- Shohei Kikuchi
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
| | - Makiko Muro
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
- Center for Medical Residency Training, Toyama University Hospital, Toyama, Japan
| | - Yusuke Kamihara
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
| | - Akinori Wada
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
| | - Jun Murakami
- Division of Transfusion Medicine and Cell Therapy, Toyama University Hospital, Toyama, Japan
| | - Yoshimi Nabe
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
| | - Tomoki Minemura
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
| | - Tsutomu Sato
- Department of Hematology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0152 Japan
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Im D, Alsheimer K, Poulose J, Zeykan V, Talamo G. Relapse of Lung Adenocarcinoma Manifested by Spontaneous Tumor Lysis Syndrome. Case Rep Oncol 2023; 16:1306-1310. [PMID: 37942403 PMCID: PMC10629853 DOI: 10.1159/000534398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Tumor lysis syndrome (TLS) is an oncologic emergency characterized by several metabolic derangements, such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. TLS is typically observed in hematologic malignancies, especially after starting the first administration of antineoplastic therapies. TLS in a solid malignancy is very unusual, and exceedingly rare when occurring spontaneously, in the absence of chemotherapy. Case Presentation We report a case of a 76-year-old man with lung adenocarcinoma, which started as a cancer with indolent behavior and small tumor burden but relapsed in 5 months with rapidly proliferating metastatic disease. Spontaneous TLS was the presenting clinical manifestation of the tumor relapse, and it led to the patient's death. Conclusion To our knowledge, this is the first case of spontaneous TLS in a relapsed adenocarcinoma of the lung reported in the medical literature. The development of the metabolic derangements of TLS should prompt the consideration of tumor relapse during the follow-up of patients with solid malignancies.
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Affiliation(s)
- Daebin Im
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Katie Alsheimer
- Pulmonary and Critical Care, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Joyson Poulose
- Hematology-Oncology, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Violeta Zeykan
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Giampaolo Talamo
- Hematology-Oncology, Guthrie Robert Packer Hospital, Sayre, PA, USA
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20
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Furusawa M, Matsuishi K, Horino K, Inoue H, Abe M, Oya N. A Case of Tumor Lysis Syndrome during Palliative Radiotherapy for Breast Cancer Metastases. Case Rep Oncol 2023; 16:1060-1065. [PMID: 37900788 PMCID: PMC10601727 DOI: 10.1159/000531925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/20/2023] [Indexed: 10/31/2023] Open
Abstract
Tumor lysis syndrome (TLS) is the rapid disintegration of a malignant tumor treated with anticancer drugs or radiation, causing electrolyte abnormalities such as elevated uric acid levels, elevated potassium and phosphorus levels, and decreased calcium levels. These abnormalities can lead to hypotension, renal dysfunction, consciousness disorders, and even death in some cases. The current patient was a 65-year-old woman who had breast cancer with local invasion, lung metastasis, and bone metastasis from the time of the initial disease onset. Despite the administration of various chemotherapy and hormone therapy regimens, the tumor increased gradually, and at 2 years and 5 months after the initial onset, pain and bleeding from metastatic infiltration of the cervical lymph nodes were noted. Therefore, radiotherapy was indicated for palliation of pain and bleeding caused by metastatic invasion of the cervical lymph nodes. Irradiation (30 Gy/10fr) was planned with a 3-field technique using 4MVX and 10MVX. Approximately 11 h after the initial irradiation, symptoms such as respiratory distress, tachycardia, and hypotension were observed. Blood tests revealed hyperuricemia and hyperkalemia, leading to a diagnosis of TLS. Dialysis and electrolyte correction were immediately initiated resulting in normalization of electrolytes and stabilization of the blood pressure. It is crucial to understand that TLS is relatively rare but can occur after radiation therapy or in solid tumors, and warrants a prompt response if suspected based on symptoms or blood findings.
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Affiliation(s)
- Mitsuhiro Furusawa
- Department of Radiation Oncology, Kumamoto General Hospital, Kumamoto, Japan
| | - Kozue Matsuishi
- Department of Surgery, Kumamoto General Hospital, Kumamoto, Japan
| | - Kei Horino
- Department of Surgery, Kumamoto General Hospital, Kumamoto, Japan
| | - Hideki Inoue
- Department of Nephrology, Kumamoto General Hospital, Kumamoto, Japan
| | - Michio Abe
- Department of Surgery, Minamata City General Hospital and Medical Center, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
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Barakat S, Abdallah B, Finianos A, Mahmasani LA. Tumor Lysis Syndrome: A Rare Complication of Metastatic Gastric Cancer and a Possible Indicator of Disease Progression. Clin Med Insights Case Rep 2022; 15:11795476221129238. [PMID: 36277906 PMCID: PMC9585557 DOI: 10.1177/11795476221129238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022]
Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency that is usually associated with hematologic malignancies either spontaneously or following early chemotherapy and is caused by massive tumor cell lysis. However, it has been rarely reported in solid tumors. We report a case of 25-year-old lady recently diagnosed with metastatic gastric adenocarcinoma who developed TLS after the fourth cycle of chemoimmunotherapy (FOLFOX plus Nivolumab). She presented with abdominal pain, decrease in oral intake and decreased urine output. Laboratory studies showed acute kidney injury with electrolyte disturbances and was diagnosed initially with autoimmune nephritis secondary to Nivolumab but was later found to have TLS and recovered after appropriate treatment. Soon after this complication, our patient was found to have disease progression on imaging which makes the incidence of TLS an indicator of disease progression.
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Affiliation(s)
- Salim Barakat
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Batoul Abdallah
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Antoine Finianos
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Layal Al Mahmasani
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon,Layal Al Mahmasani, Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Cairo Street, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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22
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Abdel-Nabey M, Chaba A, Serre J, Lengliné E, Azoulay E, Darmon M, Zafrani L. Tumor lysis syndrome, acute kidney injury and disease-free survival in critically ill patients requiring urgent chemotherapy. Ann Intensive Care 2022; 12:15. [PMID: 35166948 PMCID: PMC8847484 DOI: 10.1186/s13613-022-00990-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background Tumor lysis syndrome (TLS) is a life-threatening complication during the treatment of malignant neoplasia. We sought to describe characteristics and predictors of acute kidney injury (AKI), remission and mortality in high-risk TLS patients. In this retrospective monocentric study, we included all patients with the diagnosis of biological and/or clinical TLS from 2012 to 2018. The primary outcome was the prevalence of AKI during the acute phase of TLS. Secondary outcomes were overall mortality and remission of the underlying malignancy at 1 year. Results Among 153 patients with TLS, 123 (80.4%) patients experienced AKI and 83 (54.2%) required renal replacement therapy. mSOFA score (OR = 1.15, IC 95% [1.02–1.34]), age (OR = 1.05, IC 95% [1.02–1.08]) and male gender (OR = 6.79, IC 95% [2.59–19.44]) were associated with AKI. Rasburicase use (HR = 2.45, IC 95% [1.17–5.15]) was associated with remission of the underlying malignancy at 1 year. Parameters associated with mortality at 1 year were mechanical ventilation (HR = 1.96, IC 95% [1.02–3.78]), vasopressors (HR = 3.13, IC 95% [1.59–6.15]), age (HR = 1.02, IC 95% [1–1.03]), spontaneous TLS (HR = 1.65, IC 95% [1.01–2.69]) and delay of chemotherapy administration (HR = 1.01, IC 95% [1–1.03]). Conclusions AKI is highly prevalent in TLS patients. Rasburicase is associated with better outcomes regarding remission of the underlying malignancy. As rasburicase may be an indirect marker of a high degree of tumor lysis and chemosensitivity, more studies are warranted to confirm the protective role of urate oxidase. Delaying chemotherapy may be deleterious in terms of long-term outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00990-1.
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Affiliation(s)
- Moustafa Abdel-Nabey
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Justine Serre
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Etienne Lengliné
- University of Paris, Paris, France.,Hematology Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.,University of Paris, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France. .,University of Paris, Paris, France. .,INSERM UMR 976, University of Paris, Paris, France.
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Lemerle M, Schmidt A, Thepot-Seegers V, Kouatchet A, Moal V, Raimbault M, Orvain C, Augusto JF, Demiselle J. Serum phosphate level and its kinetic as an early marker of acute kidney injury in tumor lysis syndrome. J Nephrol 2022. [PMID: 35107777 DOI: 10.1007/s40620-022-01263-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a major cause of mortality in tumor lysis syndrome. The biochemical parameters and kinetics of tumor lysis syndrome remain poorly described. Particularly, whether blood serum phosphate variations may help in the identification and management of patients who will eventually develop AKI remains to be studied. METHODS In this retrospective study, we included patients with tumor lysis syndrome episodes without AKI at diagnosis, and analyzed serum phosphate kinetic, clinical and tumor lysis syndrome biochemical variables to identify factors associated with AKI onset, and determine threshold values of phosphatemia associated with AKI development. RESULTS One hundred thirty tumor lysis syndrome episodes occurred in 120 patients during an 11-year period at the University Hospital of Angers. AKI developed in 56 tumor lysis syndrome episodes. In multivariable analysis, among the analyzed factors, only an increase in serum phosphate levels (before AKI diagnosis), exposure to platinum salts and an increase in LDH levels were associated with AKI development. Before AKI onset, a serum phosphate cut-off of 2.1 mmol/L was not effective in predicting AKI development (sensitivity 48%, specificity 84%, area under the receiver operating characteristic curve (AUC) 0.63 [0.52-0.74]). No other biochemical parameters were effective to better predict AKI occurrence. CONCLUSION This work suggests that increases in serum phosphate and LDH appear to be early and reliable biomarkers of AKI in tumor lysis syndrome. No valuable threshold value of serum phosphate was found to effectively predict AKI. This work is the basis for further prospective controlled studies on phosphate monitoring and phosphate lowering therapies to prevent AKI during tumor lysis syndrome.
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Watanabe S, Nanke I, Uchidate K, Machida T, Igarashi A, Kobashi K, Negi M, Yauchi T. Case report of recurrent spontaneous tumor lysis syndrome in a patient with esophageal cancer recovered via chemotherapy. Int Cancer Conf J 2022; 11:97-103. [PMID: 35402131 PMCID: PMC8938533 DOI: 10.1007/s13691-021-00514-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/06/2021] [Indexed: 01/26/2023] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threatening oncological emergency. Only one TLS case has been reported in patients with esophageal cancer. We report the case of a 61-year-old man with recurrent spontaneous TLS caused by esophageal cancer. He was admitted to our hospital to investigate low back pain and dysphagia. Endoscopy and computed tomography revealed esophageal cancer with multiple liver and bone metastases. He was diagnosed with laboratory TLS based on high serum uric acid and phosphorus. After intravenous fluids and allopurinol were administrated, chemotherapy with 5-fluorouracil and cisplatin was started the next day. Although he transiently developed clinical TLS, it was resolved with conservative treatment. However, mild renal dysfunction was prolonged and cisplatin was reduced in the second course. As a consequence, recurrence of spontaous TLS (sTLS) was induced at the end of the course. In the third course, docetaxel was added to the regimen, and since then the patient have not develop sTLS. To the best of our knowledge, this is the first report regarding recurrent sTLS developed on the basis of solid tumors and was successfully controlled by chemotherapy. Although TLS complications are rare in esophageal cancer, early diagnosis and the adjustment of regimen resulted in stable chemotherapy.
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Affiliation(s)
- Sho Watanabe
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Ittoku Nanke
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Kozue Uchidate
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Tomoyo Machida
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Akira Igarashi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Kenichiro Kobashi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
| | - Mariko Negi
- Department of Pathology, Soka Municipal Hospital, Saitama, Japan
| | - Tsunehito Yauchi
- Department of Gastroenterology, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560 Japan
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25
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Huang YC, Huang FL, Tsai SF, Jan SL, Fu LS. Pseudohyperkalemia accompanying actual hyperphosphatemia and hypocalcemia in an adolescent with T-lymphoblastic lymphoma. Clin Biochem 2021; 101:5-8. [PMID: 34922929 DOI: 10.1016/j.clinbiochem.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
Tumor lysis syndrome (TLS) is a life-threatening condition that may occur in patients with lymphoma, leukemia, or cancers with high cellular burdens. Without appropriate treatment, electrolyte imbalances, namely hyperkalemia, hyperphosphatemia, and hypocalcemia, can be fatal in patients with TLS. In pseudohyperkalemia, concurrent hyperphosphatemia and hypocalcemia can render devising a treatment strategy challenging. We report an adolescent with T-lymphoblastic lymphoma who presented with pseudohyperkalemia but actual hyperphosphatemia and hypocalcemia, to highlight the importance of accurate clinical interpretations of laboratory data in patients with TLS.
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Affiliation(s)
- Yung-Chieh Huang
- Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Liang Huang
- Division of Hematology and Oncology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Hung Kuang University, Taichung, Taiwan; Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Shang-Feng Tsai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan; College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Sheng-Ling Jan
- Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lin-Shien Fu
- Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan.
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Cailleteau A, Touzeau C, Jamet B, Guimas V, Jouglar E, Supiot S. Cytokine release syndrome and tumor lysis syndrome in a multiple myeloma patient treated with palliative radiotherapy: A case report and review of the literature. Clin Transl Radiat Oncol 2021; 32:24-28. [PMID: 34816023 PMCID: PMC8591462 DOI: 10.1016/j.ctro.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/27/2022] Open
Abstract
We present the case of a 53-year-old woman treated with analgesic radiotherapy for a multiple myeloma bone lesion of the forearm. After a first fraction of 5 Gray (Gy), she presented with an acute respiratory syndrome with fever a few hours after the treatment. The same symptoms occurred after the second fraction 3 days later. The patient recovered quickly thanks to intravenous hydration and suspension of the radiotherapy. Biological tests revealed a tumor lysis syndrome. We concluded that the clinical symptoms could be defined as cytokine release syndrome. This is the second time in the literature that cytokine release syndrome has been described following radiotherapy. First, we synthesize TLS and radiotherapy to determine how radiotherapy could be a trigger associated with other well-known factors. Furthermore, we discuss radiotherapy and cytokine release syndrome. Summary We present the case of a woman treated with analgesic radiotherapy for a multiple myeloma bone lesion. Following the first and the second treatment fraction, the patient presented with an acute respiratory syndrome with fever and biological tests revealed a tumor lysis syndrome. We concluded that the clinical symptoms could be defined as cytokine release syndrome. Furthermore, we discuss how radiotherapy could be a trigger of cytokine release syndrome and tumor lysis syndrome in association with chemotherapy drugs.
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Affiliation(s)
- Axel Cailleteau
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Cyrille Touzeau
- Department of Hematology, Centre Hospitalier Universitaire, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Site de Recherche Intégrée sur le Cancer (SIRIC), ILIAD, Nantes, France
| | - Bastien Jamet
- Nuclear Medicine Department, University Hospital of Nantes, Nantes, France
| | - Valentine Guimas
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France.,Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), UMR 1232 Inserm - 6299 CNRS, Institut de Recherche en Santé de l'Université de Nantes, Nantes, France
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27
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Pochon C, Courbon C, Bay JO, Moreau AS, Paul F, Picard M, Sterin A, Tudesq JJ, Vicente C, Yakoub-Agha M, Yakoub-Agha I. [Complications other than infections, CRS and ICANS following CAR T-cells therapy: Recommendations of the Francophone Society of bone marrow transplantation and cell therapy (SFGM-TC)]. Bull Cancer 2021; 108:S98-S103. [PMID: 34802718 DOI: 10.1016/j.bulcan.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
CAR-T cells are an innovative treatment for an increasing number of patients, particularly since the extension of their indication to mantle lymphoma and multiple myeloma. Several complications of CAR T-cell therapy, that were first described as exceptional, have now been reported in series of patients, since its first clinical use in 2011. Among them, cardiac complications, delayed cytopenias, acute and chronic Graft versus Host Disease, and tumoral lysis syndrome are recognized as specific potent complications following CAR T-cells infusion. During the twelfth edition of practice harmonization workshops of the Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC), a working group focused its work on the management of these complications with focuses the epidemiology, the physiopathology and the risk factors of these 4 side effects. Our recommendations apply to commercial CAR-T cells, in order to guide strategies for the management of complications associated with this new therapeutic approach.
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Affiliation(s)
- Cécile Pochon
- CHRU de Nancy, service d'onco-hématologie pédiatrique, 54500 Vandœuvre-Lès-Nancy, France; Université de Lorraine, UMR 7365 CNRS-UL IMoPA, campus biologie santé, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-Lès-Nancy, France.
| | - Corinne Courbon
- Institut de cancérologie de la Loire, service d'hématologie, 42270 Saint-Priest-en-Jarez, France
| | - Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, site Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - Anne-Sophie Moreau
- Hôpital Salengro, CHU de Lille, service de médecine intensive réanimation, rue Émile-Laine, 59037 Lille cedex, France
| | - Franciane Paul
- Université Montpellier, CHU de Montpellier, département d'hématologie clinique, Montpellier, France
| | - Muriel Picard
- CHU de Toulouse, réanimation polyvalente IUCT-oncopole, Toulouse, France
| | - Arthur Sterin
- Hôpital La Timone Enfants, service hémato-immunologie pédiatrique, 13005 Marseille, France
| | - Jean-Jacques Tudesq
- Université Montpellier, CHU de Montpellier, département d'hématologie clinique, Montpellier, France
| | - Céline Vicente
- CHU de Toulouse, service d'hématologie, IUCT-oncopole, 1, avenue Joliot-Curie, 31059 Toulouse, France
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Zhao J, Miller H, Blake EA. Tumor lysis syndrome in advanced and high-grade endometrial cancers: A case report and review of the literature. Gynecol Oncol Rep 2021; 37:100761. [PMID: 34621942 PMCID: PMC8484496 DOI: 10.1016/j.gore.2021.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/03/2022] Open
Abstract
Tumor lysis syndrome is a rare but deadly complication of solid tumors. We suggest that tumor lysis syndrome is especially deadly when it results from high grade or metastatic endometrial cancers. Consider prophylactic measures to prevent tumor lysis syndrome in high risk patients before initiating therapy.
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Affiliation(s)
- Johnathan Zhao
- Division of Obstetrics and Gynecology, The Cleveland Clinic, Cleveland, OH, USA
| | - Heather Miller
- Division of Gynecologic Oncology, University of Southern California, Los Angeles, CA, USA
| | - Erin A. Blake
- Division of Gynecologic Oncology, Presbyterian Cancer Care, Rio Rancho, NM, USA
- Corresponding author at: Department of Gynecologic Oncology, Presbyterian Cancer Care, 2400 Unser Blvd, Rio Rancho, NM 87124, USA.
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Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency due to massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Clinical presentation is characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Acute kidney injury due to tumor lysis is potentiated by the precipitation of uric acid and calcium phosphate as well as renal vasoconstriction. Early recognition of tumor lysis can help prevent cardiac arrhythmias, seizures, and death. Management includes intravenous hydration to maintain urine flow, medications targeting hyperuricemia including rasburicase and allopurinol and in severe cases renal replacement therapy may be required.
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30
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Ozturk E, Erdogan Ozunal I. A Rare Side Effect of Ibrutinib: Tumor Lysis Syndrome. Medeni Med J 2021; 36:176-179. [PMID: 34239769 PMCID: PMC8226401 DOI: 10.5222/mmj.2021.56424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/12/2021] [Indexed: 11/05/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a progressive disease with an indolent course, and tumor lysis syndrome (TLS) is rarely seen in CLL. Ibrutinib is a novel bruton kinase (BTK) inhibitor increasingly used in CLL treatment. Ibrutinib has significant side effects such as atrial fibrillation, bleeding, diarrhea, and infections. However, TLS is reported rarely with ibrutinib treatment. This report focuses on a 69-year-old female patient diagnosed with relapsed CLL who developed grade 4 TLS after ibrutinib monotherapy. The patient developed TLS on the third day of ibrutinib treatment necessitating discontinuation of the treatment and initiation of hemodialysis and supportive care. Ibrutinib treatment was re-initiated at a daily dose of 140 mg therapy after an interval of seven days, and then any additional side effect was not seen. Tumor lysis syndrome secondary to ibrutinib has been reported in an increasing number of cases. There is currently no information on managing adverse effects of TLS attributed to ibrutinib. Consequently, ibrutinib treatment of this patient was not terminated, and restarted after a short interval. It must not be forgotten that TLS secondary to ibrutinib treatment may be rarely seen, and can be life-threatening. Treatment with ibrutinib should be initiated in consideration of this side effect, and the development of complication of TLS may not necessitate discontinuation of ibrutinib treatment.
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Affiliation(s)
- Erman Ozturk
- Istanbul Medeniyet University Faculty of Medicine, Department of Hematology, Istanbul, Turkey
| | - Isıl Erdogan Ozunal
- Goztepe Prof Dr Suleyman Yalcın City Hospital, Department of Hematology, Istanbul, Turkey
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31
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Oyama C, Arakawa Y, Ikeda Y, Aoki T, Kubota Y, Isobe K, Mori M, Kurihara J, Koh K. [Chronic-phase chronic myeloid leukemia with intracranial hemorrhage complicated with tumor lysis syndrome]. Rinsho Ketsueki 2021; 62:346-351. [PMID: 34108312 DOI: 10.11406/rinketsu.62.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 14-year-old male with autism was admitted to our hospital owing to altered consciousness and gait disturbance. Blood tests showed a white blood cell (WBC) count of 728,600/µl, and brain computed tomography revealed intracranial hemorrhage and a midline shift of the brain. The chronic phase of chronic myeloid leukemia (CML) was confirmed as per bone marrow aspiration findings. The patient underwent emergency craniotomy for hematoma removal, and he subsequently received hydroxyurea and rasburicase combination therapy. However, he developed tumor lysis syndrome (TLS) and died on the second day of hospitalization. Histopathological examination of autopsy specimens did not reveal any condition that could account for his death other than CML. Several reports have described intracranial hemorrhage during the accelerated phase or blast crisis of CML, but few have described this complication during the chronic phase. TLS concomitant with CML in the chronic phase or following hydroxyurea (an inhibitor of DNA synthesis) administration is rare. It is essential for clinicians to be aware that patients with chronic phase CML and high WBC counts may develop TLS, following the administration of hydroxyurea alone. In addition, extreme caution is warranted in severe cases accompanied by intracranial hemorrhage.
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Affiliation(s)
- Chigusa Oyama
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Yuki Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Yuhachi Ikeda
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Takahiro Aoki
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Yasuo Kubota
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Kiyotaka Isobe
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children's Medical Center
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center
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Stephanos K, Dubbs SB. Pediatric Hematologic and Oncologic Emergencies. Emerg Med Clin North Am 2021; 39:555-571. [PMID: 34215402 DOI: 10.1016/j.emc.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pediatric hematologic and oncologic emergencies are in 3 major categories: complications of hematologic disorders, emergencies associated with the new onset of cancers, and treatment-associated oncologic emergencies. The overall number of these patients remains low; however, the mortality associated with these diseases remains high despite significant advances in management. This article presents a review of the most commonly encountered pediatric hematologic and oncologic complications that emergency physicians and providers need to know.
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Affiliation(s)
- Kathleen Stephanos
- Departments of Emergency Medicine and Pediatrics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 655, Rochester, NY 14642, USA.
| | - Sarah B Dubbs
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/sbuidubbs
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33
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Vachhani P, Baron J, Freyer CW, Miller A, Wetzler M, Thompson JE, Griffiths EA, Wang ES. A phase 2 trial of single low doses of rasburicase for treatment of hyperuricemia in adult patients with acute leukemia. Leuk Res 2021; 107:106588. [PMID: 33957371 DOI: 10.1016/j.leukres.2021.106588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rasburicase can markedly and rapidly decrease uric acid (UA) levels, thereby preventing and treating tumor lysis syndrome. However, rasburicase is expensive, especially when used as per the manufacturer's recommended dosage of 0.2 mg/kg/day for up to 5 days. Numerous reports have shown that lower, and even single doses are effective in lowering UA levels but prospective randomized studies comparing low doses have not been performed. OBJECTIVES To prospectively determine the efficacy and safety of two single low doses of rasburicase in adult patients (pts) with acute leukemia and elevated plasma UA. METHODS Eligible pts aged ≥ 18 years old with acute leukemia and UA ≥ 7.5 mg/dL were randomized to receive an initial single dose of rasburicase 1.5 mg (Arm A) or 3 mg (Arm B) on day 1 in an unblinded fashion. All pts received allopurinol 300 mg daily on days 1-6. RESULTS Twenty-four pts (median age 69 years; 14 males and 10 females) were enrolled in this phase 2 study (12 on each arm). Twenty pts had acute myeloid leukemia while 3 had acute lymphoblastic leukemia, and 1 had acute promyelocytic leukemia. Median initial UA level was 9.8 mg/dL. Eighty-three percent of pts in both arms achieved UA < 7.5 mg/dL by 24 h after therapy. Five pts (21 %; 2 from Arm A and 3 from Arm B) required additional doses of rasburicase. The majority (23/24) of pts achieved UA goals after 1-2 doses of rasburicase. None had worsening renal function. Both doses were well tolerated, and no treatment related adverse events were reported. CONCLUSIONS Single doses of rasburicase (as low as 1.5-3 mg) used in addition to allopurinol were well tolerated and highly efficacious (83 % response rate) in decreasing UA levels within 24 h of administration in adult acute leukemia pts with hyperuricemia.
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Affiliation(s)
- Pankit Vachhani
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
| | - Jeffrey Baron
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Craig W Freyer
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Austin Miller
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Meir Wetzler
- Section of Leukemia, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - James E Thompson
- Section of Leukemia, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elizabeth A Griffiths
- Section of Leukemia, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Eunice S Wang
- Section of Leukemia, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Abstract
OBJECTIVES To provide an overview of tumor lysis syndrome, which is one of the metabolic oncologic emergencies. DATA SOURCES A review and synthesis of empirical articles. CONCLUSION One of the metabolic oncologic emergencies identified by the Oncology Nursing Society is tumor lysis syndrome. This condition is life-threatening and is characterized by metabolic derangements that can lead to acute kidney injury and multiple organ dysfunction. Normal intracellular components (potassium, phosphorus, and nucleic acids) spill into the bloodstream when cancer cells die. If the tumor is large and highly responsive to chemotherapy, the resulting cascade of dead tumor cells may overwhelm normal homeostatic mechanisms. The cells enter the bloodstream faster than they can be cleared by the kidneys. This results in hyperkalemia and hyperphosphatemia. Nucleic acids convert to uric acid in the liver with a resultant hyperuricemia. Excess uric acid in the kidneys can lead to uric acid nephropathy and renal insufficiency. Phosphorus binds with calcium, leading to hypocalcemia from the formation of calcium phosphate precipitate or crystals. These crystals can also lead to renal insufficiency or acute kidney injury, which can lead to a metabolic acidosis and exacerbation of the hyperkalemic state. These metabolic derangements define presence of tumor lysis syndrome. IMPLICATIONS FOR NURSING PRACTICE Multidisciplinary collaboration and communication is essential to identifying patients at risk prior to treatment. Meticulous nursing care in terms of prevention and treatment is critical to patient survival.
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Abstract
Current advances in cancer chemotherapeutics have remarkably helped in rapid and definitive treatment options. However, these potent chemotherapeutics have been associated with severe renal toxicities that later impact treatment options. Acute kidney injury is common in patients with cancer. In hospitalized patients with cancer, acute kidney injury is associated with increased morbidity, mortality, length of stay, and costs. This article provides an overview of acute kidney injury caused by cancer or its treatment, including prerenal, tubular, glomerular diseases, infiltrative disease, tumor lysis syndrome, anticancer drug nephrotoxicity, hematopoietic stem cell transplantation-related acute kidney injury, and cancer-associated thrombotic microangiopathy.
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Affiliation(s)
- Jaya Kala
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, 6431 Fannin Street, MSB 5.134, Houston, TX 77030, USA.
| | - Kevin W Finkel
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, 6431 Fannin Street, MSB 5.134, Houston, TX 77030, USA
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Shimizu Y, Sunagozaka H, Yamagata K, Hirai H, Miura M, Yonemoto Y, Naito Y, Hasatani K, Yoshikawa J, Aoyagi H, Kaneko S. Lenvatinib-induced tumor lysis syndrome in a patient with advanced hepatocellular carcinoma: a case report. Clin J Gastroenterol 2021; 14:645-649. [PMID: 33389590 DOI: 10.1007/s12328-020-01306-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency caused by release of intracellular tumor components due to massive tumor lysis and is rare in patients with hepatocellular carcinoma (HCC). We describe a case of TLS with rupture of HCC induced by lenvatinib in a patient with advanced HCC. A 72-year-old man who presented with right upper abdominal pain was diagnosed as having advanced HCC with a high tumor burden by contrast-enhanced computed tomography and percutaneous hepatic tumor biopsy. He was started on lenvatinib 12 mg once daily when his tumor progressed despite one-shot hepatic arterial infusion chemotherapy. On day 2 of treatment with lenvatinib, he developed severe upper abdominal pain and was diagnosed as having TLS with HCC rupture by laboratory tests and contrast-enhanced computed tomography. Urgent treatment with transarterial embolization, hemodialysis, and blood transfusion therapy was successful. The patient was then restarted on oral lenvatinib at a reduced dose without recurrence of TLS. TLS is a rare potential complication of lenvatinib in patients with advanced HCC and a high tumor burden.
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Affiliation(s)
- Yoshiaki Shimizu
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan.
| | - Hajime Sunagozaka
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Koki Yamagata
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Hirokazu Hirai
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Miyabi Miura
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Yuichiro Yonemoto
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Yoshihide Naito
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Kenkei Hasatani
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Jun Yoshikawa
- Department of Radiology, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroyuki Aoyagi
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui City, Fukui, 910-8526, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
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Kondo M, Hotta Y, Yamauchi K, Sanagawa A, Komatsu H, Iida S, Kimura K. Bortezomib administration is a risk factor associated with the development of tumor lysis syndrome in male patients with multiple myeloma: a retrospective study. BMC Cancer 2020; 20:1117. [PMID: 33203424 PMCID: PMC7672870 DOI: 10.1186/s12885-020-07592-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Although multiple myeloma is a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. Previous studies, mostly case reports or case series, have reported bortezomib-induced TLS in patients with multiple myeloma. This study aimed to investigate risk factors associated with TLS development in multiple myeloma patients. METHODS We retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between TLS and several parameters previously reported to be associated with increased risk. RESULTS This study included 210 patients with multiple myeloma, of which ten (4.8%) had LTLS and seven (3.3%) had CTLS. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between patients with and without TLS. Multivariate analyses revealed that TLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of TLS (odds ratio = 8.51, P = 0.046). CONCLUSION In the present study, we investigated the risk factors associated with TLS development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients' backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, since a significant number of novel therapies can achieve high antitumor responses.
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Affiliation(s)
- Masahiro Kondo
- Department of Pharmacy, Nagoya City University Hospital, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan
| | - Yuji Hotta
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1, Tanabe dori, Mizuho ku, Aichi, 467-8603, Nagoya, Japan
| | - Karen Yamauchi
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1, Tanabe dori, Mizuho ku, Aichi, 467-8603, Nagoya, Japan
| | - Akimasa Sanagawa
- Department of Pharmacy, Nagoya City University Hospital, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1, Tanabe dori, Mizuho ku, Aichi, 467-8603, Nagoya, Japan
| | - Hirokazu Komatsu
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan
| | - Kazunori Kimura
- Department of Pharmacy, Nagoya City University Hospital, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan.
- Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1, Tanabe dori, Mizuho ku, Aichi, 467-8603, Nagoya, Japan.
- Department of Clinical Pharmaceutics, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan.
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38
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Abstract
The recognition and management of oncologic emergencies are becoming increasingly relevant in the intensive care unit, particularly in the era of novel biologic therapies. Early recognition and multidisciplinary collaboration are essential to improving patient outcomes. This article discusses aspects of diagnosis and management for important malignancy-associated emergencies.
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Affiliation(s)
- Jenna Spring
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Sinai Health System and University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D108, Toronto, Ontario M4N 3M5, USA. https://twitter.com/jennaspring
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Sinai Health System and University Health Network, Toronto, Ontario, Canada; Mount Sinai Hospital, 600 University Avenue, Suite 18-206, Toronto, Ontario M5G 1X5, Canada.
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39
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Abstract
Tumor lysis syndrome is a life-threatening condition for humans due to the lack of urate oxidase. In this study, several variants of PASylated uricase from the Aspergillus flavus species were analyzed computationally to find the appropriate fusions to solve short half-life and stability concern. The Ab initio method was performed using Rosetta software to structurally characterize the PAS sequences. The 3D structures of fusions were predicted for fused C- or N-terminally PAS sequences in different length to the uricase. The refinement and energy minimization steps revealed that physicochemical and conformational properties of fusions improved while the structures possessed prolonged PAS sequences. Molecular docking results showed that the highest binding affinity to uric acid belonged to uricase-PAS1-100 by the formation of six hydrogen and four non-hydrogen bonds. Altogether, the results indicated that the PASylation process would be promising upon the production of urate oxidase with improved solubility and stability.
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Affiliation(s)
- Abbas Najjari
- Enzyme Technology Laboratory, Department of Biochemistry,Genetic and Metabolism Research Group, Pasteur Institute of Iran,Tehran, Iran
| | - Hamzeh Rahimi
- Molecular Medicine Department, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Ali Nojoumi
- Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Eskandar Omidinia
- Enzyme Technology Laboratory, Department of Biochemistry,Genetic and Metabolism Research Group, Pasteur Institute of Iran,Tehran, Iran
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40
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Yen TH, Chang CH, Shiu SI. Tumor Lysis Syndrome after Combination Therapy of Nivolumab and Sorafenib in a Woman with Advanced Hepatocellular Carcinoma. Case Rep Gastroenterol 2020; 14:367-372. [PMID: 32884512 PMCID: PMC7443662 DOI: 10.1159/000508583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/01/2020] [Indexed: 11/19/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threatening emergency that usually develops in rapidly proliferating hematologic malignancies or advanced solid tumor following cytotoxic chemotherapy or therapeutic interventions. TLS is especially rare in patients with hepatocellular carcinoma (HCC). Therefore, we present a case of a female patient with newly diagnosed advanced HCC who developed TLS and hepatic failure after receiving combination therapy of nivolumab and sorafenib. To our knowledge, this is the first case of TLS in a patient with advanced HCC owing to combination therapy of nivolumab and sorafenib. We also reviewed the literature and summarized the characteristics of TLS in patients with advanced HCC receiving various therapeutic interventions. The overall mortality rate was 63% and regarding the management, transarterial chemoembolization (TACE) was the most common etiology. TACE-related TLS developed more rapidly than sorafenib-related TLS. Furthermore, the efficacy and safety of combination therapy of nivolumab and sorafenib should be further evaluated, and TLS should still be a concern, especially in patients with large tumor burden.
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Affiliation(s)
- Tsai-Hung Yen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Evidence-Based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan
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41
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Park Y, Chung BH, Park CW, Kim YS, Yang CW. Acute kidney injury with extreme hyperuricemia after antithymocyte globulin treatment in a kidney transplant recipient with underlying aplastic anemia: a case report. BMC Nephrol 2020; 21:251. [PMID: 32615929 PMCID: PMC7330935 DOI: 10.1186/s12882-020-01903-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurrences of hyperuricemia and acute kidney injury after antithymocyte globulin treatment are unusual in kidney transplant recipients. Here, we report a unique case of acute kidney injury with extreme hyperuricemia after antithymocyte globulin treatment in a kidney transplant recipient with underlying aplastic anemia. CASE PRESENTATION A 40-year-old woman with aplastic anemia who received a kidney transplant 5 years 6 months before presented to our emergency department with complaints of oliguria, generalized edema, and general weakness 6 days after receiving antithymocyte globulin treatment for acute T-cell-mediated rejection. Urinalysis revealed 100 uric acid crystal particles. The blood chemistry test results showed rapid increases in serum creatinine (from 2.86 mg/dL to 5.58 mg/dL) and uric acid levels (from 10.2 mg/dL to 32.7 mg/dL), which suggested acute uric acid nephropathy. Tumor lysis syndrome was suspected to be the cause of the acute uric acid nephropathy; hence, the patient was reevaluated for aplastic anemia. Human leukocyte antigen-DR15 was positive, and flow cytometry revealed a low percentage of glycophosphatidyl inositol-deficient granulocytes (2.9%), which suggested paroxysmal nocturnal hemoglobinuria clones. These findings indicate that the previously diagnosed aplastic anemia had either originally been hypocellular myelodysplastic syndrome (MDS) or later transformed into hypocellular MDS, which is a type of bone marrow failure syndrome. CONCLUSIONS Clinicians should consider unexpected tumor lysis syndrome to be the cause of complications after antithymocyte globulin treatment in kidney transplant recipients with underlying bone marrow failure syndrome.
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Affiliation(s)
- Yohan Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Yong-Soo Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
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Sugimoto S, Terashima T, Yamashita T, Iida N, Kitahara M, Hodo Y, Shimakami T, Takatori H, Arai K, Kawaguchi K, Kitamura K, Yamashita T, Sakai Y, Shirota Y, Sato K, Mizukoshi E, Honda M, Harada K, Kaneko S. Tumor lysis syndrome in a patient with metastatic melanoma treated with nivolumab. Clin J Gastroenterol 2020; 13:935-939. [PMID: 32594423 DOI: 10.1007/s12328-020-01164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
A 79-year-old man with metastatic melanoma of the right maxillary sinus and multiple liver metastases received a single dose of nivolumab. Eight days later, he experienced impaired consciousness, accompanied by abnormal laboratory and electrocardiographic findings. He was therefore diagnosed with tumor lysis syndrome (TLS). Laboratory and electrocardiographic findings improved immediately after continuous hemodiafiltration; however, he died 22 days after receiving nivolumab. Autopsy revealed massive tumor necrosis in the liver. There are few case reports of TLS associated with immune checkpoint inhibitors, indicating that we should be prepared to manage especially in a patient with liver involvement of high tumor burden.
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Affiliation(s)
- Saiho Sugimoto
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Terashima
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Noriho Iida
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masaaki Kitahara
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuji Hodo
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, 920-0353, Japan
| | - Tetsuro Shimakami
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hajime Takatori
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kuniaki Arai
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazunori Kawaguchi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshio Sakai
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yukihiro Shirota
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, 920-0353, Japan
| | - Katsuaki Sato
- Department of Pathology, Noto General Hospital, Nanao, Ishikawa, 926-0816, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masao Honda
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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Abstract
Tumor lysis syndrome (TLS) is an oncological emergency characterized by a classic tetrad of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Risk assessment and prophylactic therapy is critical in preventing this oncological emergency. Treatment of established TLS involves aggressive hydration, electrolyte management, and the use of hypouricemic agents.
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Affiliation(s)
- Isha Puri
- Department of Hospital Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Deep Sharma
- Department of Medicine (Nephrology), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Krishna S Gunturu
- Department of Hematology and Oncology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Andaleeb A Ahmed
- Department of Anesthesiology and Perioperative Medicine, Tufts School of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
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44
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Shaforostova I, Fiedler R, Zander M, Pflumm J, März WJ. Fatal Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer: A Clinical Case of Rare Oncological Emergency. Case Rep Gastroenterol 2020; 14:255-260. [PMID: 32508557 PMCID: PMC7250380 DOI: 10.1159/000507648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a potentially life-threatening complication of chemotherapy. It usually occurs in rapidly proliferating hematological malignancies. TLS is deemed spontaneous (STLS) when it occurs prior to any cytotoxic or definite treatment. STLS is extremely rare in solid tumors. Here, we report a rare case of fatal STLS in a 47-year-old woman diagnosed with metastatic colon cancer. The patient developed acute renal failure with anuria, electrolyte disturbances, and metabolic acidosis before initiating chemotherapy. Despite appropriate management of TLS, including renal replacement therapy, she died within a few days from multiorgan failure. Only few other case reports of STLS associated with colon cancer have been reported in the literature.
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Affiliation(s)
- Inna Shaforostova
- Department of Haematology, Haemostasiology, Oncology and Pneumology, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Robert Fiedler
- Department of Radiology, Hospital Harzklinikum Dorothea Christiane Erxleben GmbH, Wernigerode, Germany
| | - Martina Zander
- Department of Pathology, Hospital Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinburg, Germany
| | - Johannes Pflumm
- Department of Internal Medicine, Hospital Harzklinikum Dorothea Christiane Erxleben GmbH, Wernigerode, Germany
| | - Wolfgang Josef März
- Department of Internal Medicine, Hospital Harzklinikum Dorothea Christiane Erxleben GmbH, Wernigerode, Germany
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Narukawa T, Hongo F, Fujihara A, Ueno A, Matsugasumi T, Ukimura O. Pazopanib after Nivolumab-Induced Tumor Lysis Syndrome in a Patient with Metastatic Clear-Cell Renal Cell Carcinoma. Case Rep Oncol 2020; 13:249-254. [PMID: 32308585 PMCID: PMC7154254 DOI: 10.1159/000506196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 01/05/2023] Open
Abstract
Nivolumab, a programmed death-1 checkpoint inhibitor, is worldwide available for metastatic renal cell carcinoma (mRCC). Limited data exist on the response to vascular endothelial growth factor receptor-tyrosine kinase inhibitor (TKI) therapy after administration of nivolumab. In this case study, we report on a patient with tumor lysis syndrome (TLS), which was induced by pazopanib after the administration of nivolumab. A 69-year-old woman with a primary diagnosis of mRCC received pazopanib as a fourth-line therapy, after sunitinib, axitinib, and nivolumab as first-, second-, and third-line therapies, respectively. Two weeks after the administration of pazopanib, she presented to the emergency room of our institution, complaining of fatigue associated with nausea and diarrhea. Her laboratory results showed hyperphosphatemia, hyperuricemia, hypocalcemia, and possible acute kidney injury; the results were consistent with TLS. Our case report highlights TLS as a potential reaction to pazopanib following nivolumab; and we consider careful observation is necessary when administering TKI after immune checkpoint inhibitors.
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Affiliation(s)
- Tsukasa Narukawa
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihisa Ueno
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Matsugasumi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
PURPOSE OF REVIEW Burkitt's lymphoma and its leukemic form (Burkitt cell acute lymphoblastic leukemia) are a highly aggressive disease. We review the classification, clinical presentation, histology, cytogenetics, and the treatment of the disease. RECENT FINDINGS Burkitt's lymphoma might be associated with tumor lysis syndrome which is a potentially fatal complication that occurs spontaneously or upon initiation of chemotherapy. Major improvements were made in the treatment of pediatric and adults population using short-course dose-intensive chemotherapy regimens, usually 1 week after a prephase induction. Addition of Rituximab to chemotherapy has become a standard of care. Relapsed/refractory disease has a very poor prognosis and the benefit from autologous/allogeneic hematopoietic stem cell transplant remains uncertain. Rituximab-based short-course dose-intensive chemotherapy is the standard of care of Burkitt's lymphoma even in the immunodeficiency-related form.
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Abstract
Extrapulmonary tuberculosis (TB) involving bone marrow can present with various manifestations, including pancytopenia, maturation arrest, hemophagocytic lymphohistiocytosis (HLH), or infiltration of the bone marrow by caseating or noncaseating granulomas causing reversible or irreversible fibrosis. Tumor lysis syndrome (TLS) is an oncologic emergency resulting from massive tumor cell lysis. Children with TB with bone marrow involvement may also present with laboratory features of TLS resulting from high catabolism and concomitant acute kidney injury (AKI), making the diagnosis difficult at times. We present a case of disseminated TB who presented to emergency with pancytopenia, AKI, and laboratory features of TLS.
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Affiliation(s)
- Viresh Swami
- Department of Pediatric Critical Care, St. John's Medical College, Bengaluru, Karnataka, India
| | - A V Lalitha
- Department of Pediatric Critical Care, St. John's Medical College, Bengaluru, Karnataka, India
| | - T K Anjan Kumar
- Department of Pediatric Critical Care, St. John's Medical College, Bengaluru, Karnataka, India
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Castellano T, Bulard BA, Staley A, Moore KN. Tumor lysis syndrome in gynecologic cancers: An uncommon but important diagnosis to recognize. Gynecol Oncol Rep 2019; 30:100514. [PMID: 31788528 PMCID: PMC6880131 DOI: 10.1016/j.gore.2019.100514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 12/04/2022] Open
Abstract
TLS treated with rasburicase is rare and associated with approximately 5% of gynecologic cancers. TLS is most frequently associated with new diagnosis of high-grade gynecologic malignancies. The most common presenting symptoms of TLS include acute kidney injury and electrolyte derangement. Early recognition and treatment of TLS can rapidly improve uric acid and electrolyte derangements.
Objectives To describe the incidence, treatment and outcomes associated with tumor lysis syndrome (TLS) in women with gynecologic cancer (GOC). Methods A retrospective multi-institutional review of TLS associated with GOC. Women presenting with an elevated serum uric acid managed with intravenous (IV) rasburicase were included. Descriptive statistics of patient demographics, clinical findings, and outcome data was completed. Results From two large academic institutions N = 18 patients were found to meet inclusion criteria from 2008 to 2018, reflecting an approximate 5% incidence of clinically treated TLS associated with GOC in our cohort. Median age was 60 years, a majority were Caucasian (n = 11, 61.1%), median BMI was 36.2. TLS was associated with a high-grade GOC in n = 17 (94.4%) cases. TLS was commonly diagnosed with a new GOC (n = 12, 70.6%) and following receipt of chemotherapy in n = 9 (50.0%) cases. Six (66.7%) patients were treated with paclitaxel or combination, five (55.5%) with a platinum or combination, and two (22.2%) with a CD47 inhibitor. Chief complaints included electrolyte and renal abnormalities (n = 11, 73.3%). Peak serum uric acid, potassium, creatinine and phosphorus levels were 14.1 mg/dL, 5.7 mEq/L, 5.1 mg/dL, and 6.8 mg/dL, respectively. Nine patients received hospice during their admission with 3 (20%) deaths occurring as inpatients. There were 12 deaths with median OS of 16 d (range: 2–87 d). Conclusions Though rare, TLS can be associated with GOC. Early recognition of presenting symptoms, laboratory findings and expedited treatment may help with electrolyte recovery; however, TLS associated with GOC may herald a rapidly deteriorating state with significant associated mortality.
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Affiliation(s)
- T Castellano
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - B A Bulard
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - A Staley
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - K N Moore
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Usui G, Hashimoto H, Uchibori Y, Usuki K, Horiuchi H, Morikawa T. Myocardial calcification in a patient with B-lymphoblastic leukemia accompanied by tumor lysis syndrome. Cardiovasc Pathol 2019; 43:107146. [PMID: 31499334 DOI: 10.1016/j.carpath.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/22/2022] Open
Abstract
Myocardial calcification, a rare disease that leads to chronic or acute heart failure and with a poor prognosis, occurs in patients with abnormal calcium-phosphorus metabolism. The association between myocardial calcification and tumor lysis syndrome has not been reported to date. A 50-year-old man with hyperthermia and general malaise presented to our hospital and was clinically diagnosed with B-lymphoblastic leukemia (B-ALL) and febrile neutropenia accompanied by septic shock. Prednisolone was administered for tumor reduction. Two to three hours later, electrocardiography demonstrated ST elevation in V4-6, and blood tests showed elevated levels of cardiac enzymes. Transthoracic echocardiogram revealed diffuse severe hypokinesis with decreased left ventricular ejection fraction. Additionally, blood tests showed that serum phosphorus level increased to 8.0 mg/dl, which was likely due to tumor lysis syndrome. Circulatory and respiratory failure due to left heart failure progressed, and he died 3 days after administration of prednisolone. Pathological autopsy revealed diffuse proliferation of atypical B-lymphoblasts in the bone marrow, which led to the pathological diagnosis of B-ALL, accompanied by necrosis. On the cut surface of the heart, the left ventricle was dilated, and patchy yellowish-brown areas were present in the epicardial-side of the myocardium and spread through the circumferential wall of the left ventricle and interventricular septum. Microscopically, myocardial fibers were granularly basophilic in that area and were revealed as calcium deposits by Von Kossa staining. He was diagnosed with myocardial calcification. The drastic increase in the serum phosphorus level caused by tumor lysis syndrome seemed to be associated with myocardial calcification.
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Hu S, Han Y, Zhang W, Zhang T, Yao X, Liu L. Cost-effectiveness analysis of rasburicase over standard of care for the prevention and treatment of tumor lysis syndrome in children with hematologic malignancies in China. J Med Econ 2019; 22:742-750. [PMID: 30939962 DOI: 10.1080/13696998.2019.1603155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: To conduct a lifetime cost-effectiveness analysis (CEA) of rasburicase compared with standard of care (SOC) for tumor lysis syndrome (TLS) in children with hematologic malignancies from the Chinese healthcare system perspective. Materials and methods: The CEA was performed using a decision tree model with a lifetime horizon. The model explores the cost-effectiveness of rasburicase vs SOC for both preventing TLS and treating established TLS among pediatric patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), and non-Hodgkin's lymphoma (NHL). Both the prophylaxis-use model and treatment-use model incorporate long-term health states of the diseases: survival without TLS and death. The efficacy data of rasburicase and SOC were obtained from published literature. Drug costs, healthcare resource utilization (HRU), and adverse event (AE) management costs were obtained via a published study with clinical experts. Costs in US dollar and quality-adjusted life year (QALY) are reported, and incremental cost-effectiveness ratios (ICERs) were also calculated. Uncertainties due to parameter fluctuations in the model were assessed through one-way sensitivity analysis and probabilistic sensitivity analysis (PSA). Results: During TLS prevention, compared with SOC, the ICER of rasburicase treatment in China are $17,580.04/QALY, $5,783.45/QALY, and $5,391.00/QALY for pediatric patients with AML, ALL, and NHL, respectively. For the established TLS treatment, compared with SOC, the ICERs of rasburicase treatment are $2,031.18/QALY, $1,142.93/QALY, and $990.37/QALY for pediatric patients with AML, ALL, and NHL, respectively. Limitations: The clinical data for SOC are based on the published study in China, and the rasburicase prevention or treatment failure rate was either calculated based on the risk ratio or directly from the clinical study among non-Chinese pediatric patients. Another study limitation was the lack of utility data for pediatric patients with TLS and without TLS. Thus, the utility scores of pediatric cancer survivors were used as an alternative. Conclusion: Rasburicase is estimated to be a cost-effective alternative to SOC in the prevention and treatment of TLS among Chinese pediatric patients with AML, ALL, and NHL.
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Affiliation(s)
- Shaoyan Hu
- a Department of Hematology , Children's Hospital of Suzhou University , Suzhou , PR China
| | - Yi Han
- b Market Access , WPP Health , Shanghai , PR China
| | - Wenjie Zhang
- b Market Access , WPP Health , Shanghai , PR China
| | | | - Xingxing Yao
- c Department of Health Economics and Outcome Research , Sanofi , Shanghai , PR China
| | - Li Liu
- c Department of Health Economics and Outcome Research , Sanofi , Shanghai , PR China
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